Manipulation and the Brain

[Diane]

This is the name of a thread on NOI (http://www.noigroup.com/cgi-bin/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=5;t=000718) that caught my eye, and to which I responded. I couldn't resist.. as a soft tissue manual therapist it was just too tempting.

I have edited and (I think) improved my response, but because they have a deadline for edits I can't go back in and fix the post there. So I've decided to post it here (with references, no less.. :) ).
“If we discredit manipulation are we not at risk of undermining other manual type techniques for the same reason (myofascial, massage, mobilizations etc)???”

I don't think so. There is a layer of "brain" all around the outside of the body, a.k.a. skin, with fibres that go straight up to the insular cortex.1,2,3,4 We could consider manual therapies as altering the nervous system through THIS organ - I think all of the manual therapies you named do this anyway to a large extent, yet there is a conceptual void that needs filling; long ago manual therapies were named for the mesoderm (deep to the skin sensors) they were supposedly targeting (e.g. myofascial) or the sort of physical movement needed to perform them (e.g. massage, mobilization). These sorts of archaic designations deflect accurate therapeutic understanding from including the perspectives that patients' own unique nervous systems may have, keep our constructs off track, bias our self-image toward being PHYSICAL therapists instead of being physical THERAPISTS.

I doubt the actual therapy procedures, the physicality of them, are discreditable. These seem to be something humans evolved doing in order to help/comfort one another, cognitively consolidated action memeplexes that appear to stem from some deep ancestral well of primate social grooming. However, the constructs that attempt to explain and inform their use do nothing but describe such treatment as something we the treatment heroes "do" unto others. This perpetuates confusion, maintains invisibility/disregard of the highly variable nervous systems at the receiving end of the interactions as passive recipients, does nothing to consider or include the highly active role that nervous systems play in their own recovery by first accepting as non-threatening, then responding to, exteroceptive input.

Manual therapy ranging from skin touch only to active skin stretch to deeper pressure into underlying bones, muscles, neural tunnels, what have you, at varying speeds, should always be kept within our scope, but framed instead as varying kinds of exteroceptive input into a living perceiving system. Rather than being framed so strictly in biomechanical language, with its attendant and unavoidable misconceptions of cause and effect, the effects produced by manual therapies should be more carefully read as responses by the patient's living perceiving system. This necessitates seeing a patient's nervous system as more of a verb than a noun. This necessitates developing abilities to stay one step ahead of that nervous system, guiding it toward better behavior/output, not overtreating the mesodermal anatomy of it, or holding that foremost in our minds.

I'm all for retaining, but renaming, all forms of manual therapy interventions as a necessary part of their long overdue upgrade; new manual therapy names should include and reflect modern pain and nervous system concepts, and a sense of the interactivity of two nervous systems working together at every level to help one of them reduce pain and improve function/freedom. I would predict that as the perception of them shifted in us, the users of these therapies, the balance of usage of them would too; I think a trend more toward less intensive and slower forms would develop.

1. Unmyelinated tactile afferents signal touch and project to insular cortex; Nature Neuroscience (2003); H. Olausson, Y. Lamarre, H, Backlund, C. Morin, B.G. Wallin, G. Starck, S. Ekholm, I. Strigo, K. Worsley, Å.B. Vallbo, and M.C. Bushnell.
2. Pain Mechanisms: Labeled Lines Versus Convergence in Central Processing, Annu. Rev. Neurosci. 2003; A.D. (Bud) Craig.
3. Antero-posterior somatotopy of innocuous cooling activation focus in human dorsal posterior insular cortex, open access 2005; L.H. Hua, I.A. Strigo, L.C. Baxter, S.C. Johnson, A.D. (Bud) Craig.
4. The Integrative Action of the Autonomic Nervous System: Neurobiology of Homeostasis 2006; W. Jänig.


All of these references can be found within or attached to this thread (http://www.somasimple.com/forums/showthread.php?t=3478). Craig and Jänig are my latest favorite researcher reads.

[BB]

Hi Diane,

An interesting thought that especially caught my eye was how the perception may change if the name is changed.

What would we rename manipulation?

[Diane]

I'm not sure. What would you rename it Cory?

[BB]

Oh boy. You are engaging the systematic part of me here. Beware!

We could name these things based on what we propose is happening.

Manipulation for example could be:
Multilayer Exteroceptive Input Causing Descending Inhibition Primarily Through Therapuetic Placebo

MEICDIPTTP

I think that would catch on like wild fire! Just think, you could be certified to provide MEICDIPTTPulative therapy!

It would be interesting if we were to categorize treatments in such a way. Maybe this would be a better category name and then manip could have its own name within the category:

High Velocity Low Amplitude input aimed to cause stimulation at skin receptors and proprioceptors

The first name is based on peripheral ectoderm targeted, change proposed to happen, means by which the change happens.

The second name is method of application of input, and specific ectodermal receptors targeted.

[Diane]

Not a bad start.. could use more work. Needs to be catchy/sticky to be an effective replacement meme. :D

Here's a thought I've had for a long time:
INcreased understanding (of the interactivity of manual therapy)---> DEcreased force/speed
Lack of understanding (")------> INcreased force/speed

[Diane]

I thought I would put this article, How we know (http://www.seedmagazine.com/news/2006/07/how_we_know.php?page=all&p=y), here, for all manual therapists. It tells the story of how our minds become more capable through practice.
Some snippets:
What we end up knowing is what we can learn how to use. We learn by doing.

Modern neuroscience can explain ... From the perspective of our brain, learning and doing are just two different verbs that refer to the same mental process. The reach of this discovery extends way beyond eighth-grade math class. In fact, the same technique that improved test scores in Boston and San Francisco and Mississippi is also partly responsible for the runaway success of Toyota and the supernatural-seeming skills of a violin soloist. And even though learning by doing might seem backward—doesn't learning precede doing?—it's how our mind works best.

mirror neurons didn't distinguish between these mechanical differences.. the same network of mirror neurons kept lighting up. These cells just itched to do something; they didn't care how it was actually done.

Before Rizzolatti's experiment, the motor cortex was the dumb jock of the brain. According to this theory, the idea to move and the motion itself were separate mental events, unfolding in different brain areas. Rizzolatti proved this wrong. The motor cortex is really designed to combine the idea—the reason we are moving—with the movement.

This revealed the essential connection between learning and doing. The human mind understands the world by interacting with it. When we see an inanimate object that we are familiar with, our mirror neurons instinctively imagine what they could do with that object. A tennis racquet causes our cells to imagine swinging it; a violin causes our cells to imagine playing it... a math equation might trigger thoughts of taking the subway. A separate brain imaging study has shown that our mirror neurons can even be activated by the sound of words. When we say "tennis" or "violin" or "algebra," cells in our motor cortex automatically get excited.

What's the point of all this neural activity? Mirror neurons let us comb the world for practical things. Because they translate our ideas into actions, they naturally focus on whatever ideas we know how to use, ignoring the abstract and the theoretical. This makes evolutionary sense. The brain, after all, is an adaptive organ: It evolved to help us cope with a world full of concrete problems, not so that we could excel at metaphysics... And even though mirror neurons are just a small cluster of cells, their predilection for action is an essential part of the human mind. They have been implicated in everything from the invention of tools to the development of language. Mirror neurons are also why most of our favorite entertainment.. involve watching other people perform... it allows kids to learn math with the help of their motor cortex.

.. the best performers had a unique training style. They tended to downplay mindless drills and rote repetition. Instead, their practice sessions were deliberate, creative and thoughtful, like the outings of the Algebra Project or the progression of a rat through a maze. They set specific goals for themselves, continuously analyzed their progress and focused on process. "A crucial part of practicing well is that you are always learning while practicing," Ericsson says.

According to Ericsson, this is how elite performers always practice. It is the secret trick of their talent, the way they become the best. Instead of treating practice as separate from the learning process--doing is what you do when you are done learning--they constantly find ways to integrate learning into their doing process, and the payoff is immense. The brain is designed to learn in a very particular way, consistently favoring the concrete over the abstract, the practical over the theoretical. If something can't be done, then we probably aren't interested in learning about it. The individuals and organizations that take advantage of this psychological principle are the ones that excel, getting the most out of themselves and their charges... neuroscience indicates there is little the mind can't accomplish. But if we remain ignorant of Dewey and the Labor-atory School, of Rizzolatti and his monkeys, of Bob Moses and newly-accelerated math students, of the winners of musical competitions and major golf championships, we will plod along in mediocrity, and fail algebra.
My bolds.

[Diane]

I think it is exactly because we learn motor skills (i.e., manual therapy) by doing (see article above), that we have such a tangle going on about how to conceptualize them (which is a separate process), how to update/reorganize/rename them so that they make sense, so they include within their constructs modern neurobiology.

Here's what I think so far: neuromodulation is active change that occurs inside the patient's system, with or without direct contact. Most of the changes include different patterns of autonomic activity including and mostly dependent on but not restricted to induced changes in interoception and blood flow.

Obviously, there is skin all round the outside of the human system. Therefore, anything we do manually to a system and any response it may elicit has to be done through skin. So therefore, dermoneuromodulation is the big category into which all others can fall - if manual treatment interaction were a wheel, dermoneuromodulation would be the hub, with various spokes coming off from it.

The tire or rim, all round the outside, would be function, how the organism intersects with their own life/body/sense of self/environment, in my little visual schematic.

Other forms of manual therapy would be the spokes. Dermoneuromodulation alone is just directed at skin and at stimulating/feeding/oxygenating the cutaneous nerves running just below skin. There are a multitude of varieties of this, including needling. But there are technique sets that attempt to go deeper ("deeper" meaning, in real terms, having an angle of entry that is more perpendicular to the body surface, which the nervous system will see as a greater or lesser threat to itself, and to which it will modulate in possibly different ways with greater or lesser degrees of success), i.e., we have dermo-neuro-MESO-modulation. The meso is in the middle, where it belongs. Types include:
1. Dermoneuro-myo-modulation (DNMM);
2. Dermoneuro-fascio-modulation (DNFM);
3. Dermoneuro-articulo-modulation (DNAM);
4. Dermoneuro-lympho-modulation (DNLM).

Number three could be further classified into two main categories, dermoneuro-axio-articulo- modulation (DNAAM), and dermoneuro-appendiculo-articulo-modulation (DNAAM). The first subset of #3 could also be known as dermoneuro-spino-articulo-modulation. Which would give it a different acronym (DNSAM) and help those limit themselves to considering the spine only, a spoke of their own. (I know they'll want their own.)

That's a start. Cory, others, do you have any suggestions?

[emad]

Diane;

Really , dermoneuro-spino-articulo-modulation:teeth: :D :zip:


dermoneuro-axio-articulo- modulation



dermoneuro-appendiculo-articulo-modulation

manipulators like huge ,complex acronym like that ,however i think we are digging trap for ourselves because we have to explain to health care professionals and patients what we mean .The trap will be to explain the concept for doctors ,and after explain convince . As nari usually says change is difficult but possible .Do not you think thus little complex ?

Noway , the issue needs great attention ,cooperation , well-understanding of the vocublary because of history making .

Cheers
Emad

[Diane]

C'mon Emad, I think DNSM or DNAAM or DNMM is shorter and less confusing than Cory's "MEICDIPTTP"... :D (..no disrespect to Cory! :angel: ).

Obviously, neuromodulation is the biggest category of all, encompassing every sort of human interaction under the sun including cultural influences on adaptive minds, as well as pharmacological inputs. The term dermoneuromodulation is but one small subset of that huge one.. but it's a starting point for organizing hands-on interactions between nervous systems, so I'll stick with it for now. Emad, anyone, feel free to improve or replace it.

[emad]

Diane :

When i first read that
Multilayer Exteroceptive Input Causing Descending Inhibition Primarily Through Therapuetic Placebo

MEICDIPTTP




I thought you are here on SS are kidding (laughing at ) of Manipulators . i did not imgine you are serious .This is too complex , and why placebo primarily .We are applying real modulation through nocicption

Emad

[BB]

Hi Emad,
That was a joke. The idea of new names and the possible categoization is not though. I like it so far Diane. I've some ideas. I'll try to post them later tonight or tomorrow if I can.

[Diane]

Cory, glad you can see where I'm trying to go with this.
Actually, Emad, you were the one who first suggested DNM, so thank you for that.

So, back to the thread:
I'm going to try to describe the logic I'm using, by using arrows.

The first word denotes the first barrier, skin. I.e., "dermo".
So dermo is first, then the next thing that is engaged is the nervous system, therefore "neuro".
Which gives us, "dermo➨neuro".

Next, most practitioners have a target "tissue" in mind. Different sorts of manual practitioners regularly default to thinking mainly of one type. E.g, massage practitioners default to muscle, hope to have an effect on muscle. Therefore, dermo➨neuro➨myo.

The last thing that occurs is a change, hopefully for the better and hopefully permanent or at least long lasting. I.e., modulation. We know it's the nervous system doing it's own outflow modulation, which is why "neuro" is in there early on, but we can add modulation on at the end. So, we get, dermo➨neuro➨myo➨modulation, or DNMM.

I tried to set it up using this form of transitional logic, to gently move people out of thinking of mesoderm first, or some way of using their hands first. I think these new terms just make more sense.

[ian s]

Thanks for posting this brilliant seed article --distributed to lots of people already . I loved the algebra and rat examples . I especially was interested in the Toyota example of 'failure', this should be a model for us all in the 'health' world . A patient yesterday -- 26 'adjustments' since Christmas --surely if he had seen a Toyota Chiro there would have been some dialogue and reflection after a visit or two -----he had tons of yellow flags and looked 'ill' --referred on to exclude any nasties- if not a reversal of the biomechanical meme infestation is needed to get him independently desensitised .

[emad]

Hi Diane and Cory :

The problem is the skin (dermo ) which can NOT be ruled out within every modulation type .Every type of soft tissue is circuled ,covered by the skin and i agree it should be included to make all professionals and practionners understand / consider it within practical application of the modulation . We still have many suggesations and ideas to think of .

Myo Dermo neuro modulation
Dermo Myo neuro modulation

Diane ,you proposed the touch of Dermo then Nervous System , we can also take the input together to the Nervous Sysem then the modulation process. I think mantaining the cocept neuromodulation as one entity gives it more sense .

We are not sure that the Nervous System takes Input from the skin then modulate then look at the muscle , i think the Nervous System looks to the whole input .

So that DermoMyo Neuromodulation is good . just a suggesation .

Cheers
Emad

[Bas]

Ok, I have to chime in with my KISS principle:
Dermo/neuro/brain modulation.
The "target" tissue many therapists want to focus on, is redundant and has too many pitfalls and cross-overs to allow specific naming. I think the only objective differences are in force, time and speed of technique -
We have strong and fast DNB (SF DNB is a double entendre- science fiction DNB)
slow sustained DNB (SS DNB);
light touch DNB (LT DNB);
and light invitational DNB (LI DNB).

Waddaya tink? :D :D :D

[Diane]

Emad,
The problem is the skin (dermo ) which can NOT be ruled out within every modulation type It is for this reason that "dermo" must be in front of the rest of the term.

Bas, I'm thinking you are right, and am liking what you're suggesting. :thumbs_up

[BB]

I like Bas' suggestion. Other than contact with the skin, these are the only things we can know for sure that we are doing anyway.

My mind is churning about on the idea of testing for the effects of each category of therapy, linking theory and outcome.

What about a distintion for hands-off, active movement interventions? Maybe they need categories of their own?

[ian s]

http://www.nytimes.com/2007/02/06/health/psychology/06brain.html?ei=5090&en=3e7d68c53f108dd2&ex=1328418000&adxnnl=1&partner=rssuserland&emc=rss&adxnnlx=1170786651-Mfo06c8anCnoYEd/noRhdw&pagewanted=all

Diane --here is the link from Deric Bownds blog on the insula --interesting information ......

[Diane]

Thanks Ian, I already have it linked in the Pharos (http://www.somasimple.com/forums/showthread.php?t=3478) folder.

[Diane]

Back here a month later, I have to ask about something I didn't notice before: Bas, in your categories,
strong and fast DNB (SF DNB is a double entendre- science fiction DNB)
slow sustained DNB (SS DNB);
light touch DNB (LT DNB);
and light invitational DNB (LI DNB)
... What does the "B" denote? :confused:

I came back here to add this link (http://discovermagazine.typepad.com/horganism/2006/12/celebrating_win.html) which is on a completely different topic, but I was drawn to this little chunk of the essay:
It is one thing to know intellectually that life is a miracle. It's quite another, however, to see it. Saints and poets aside, most of us rarely do. The psychiatrist Arthur Deikman blames our pinched perception on two innate tendencies, which he calls instrumentality and automatization. Instrumentality is our compulsion to view the world through the filter of our selfish interests. Automatization is our propensity to learn tasks so thoroughly that we perform them with little or no conscious thought.

No doubt these traits have helped us survive. Automatization is a particularly attractive cognitive feature, because it allows us to carry out more than one task at the same time; we can fret over our plummeting 401(k)'s while driving our children to their school Christmas concert. But instrumentality and automatization can also cause us to sleepwalk through much of life.

Yet now and then, we do not see the world as something to be manipulated for our ends. This recognition, which Dr. Deikman calls deautomatization, is the goal of all contemplative traditions. When an aspirant asked the 15th-century Zen master Ikkyu to write down a maxim of "the highest wisdom," Ikkyu wrote one word: "Attention." The dissatisfied aspirant asked, "Is that all?" This time, Ikkyu wrote two words: "Attention. Attention."

I look back at the history of human primate social grooming and see a wasteland of instrumentality and automatization. I look forward to the future of it, and see that paying "more attention" as HPSGs not only serves the nervous systems of our patients better and gives them more space in which to blossom properly and increasingly painfree, it is a way more interesting way to spend a day treating, full of little 'miracles' that we can learn to see and appreciate, allowing our own personal nervous systems a chance to blossom as well.

[EricM]

'B' is probably for Brain.